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Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
What are the contents of the ischio-anal fossa?Fat padPudendal canalTransversely – the inferior rectal vessels and branches of the pudendal nervePosteriorly – perineal branch S4 and perforating cutaneous nerve
Blocks of Nerves of the Trunk
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
The pudendal nerve is a branch from the sacral plexus. It derives its fibers from the second to fourth sacral spinal nerves, passes behind the greater sciatic foramen, crosses the spine of the ischium, and then enters the pudendal canal on the lateral wall of the ischiorectal fossa. At the lower part of the pudendal canal, it gives off the inferior hemorrhoidal nerve and then divides into two terminal branches (Figure 4.16): The perineal nerve, which supplies the skin of the scrotum (or labius majus) and several perineal musclesThe dorsal nerve of the penis (the dorsal nerve of the clitoris in the female)
Chronic Perineal Pain
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Giuseppe Chiarioni, William E. Whitehead
Pudendal neuralgia refers to a chronic perineal pain syndrome due to entrapment and injury of the pudendal nerve in its muscolo-osteo-aponeurotic tunnel between the sacrotuberal and sacrospinal ligaments in the absence of organic diseases that may explain symptoms.9,16 Pudendal neuralgia has been rarely described as occurring secondary to herpetic neuropathy, stretch neuropathy and post-radiotherapy neuropathy, but pudendal nerve entrapment is by far the most common aetiology.50,51 Pudendal neuralgia is also called Alcock’s canal syndrome, or pudendal canal syndrome.9,16 Burning sensation, numbness or paraesthesia in the gluteal, perineal and genital areas are also commonly reported in association with the pain.16 In addition, the pain may be unilateral or bilateral, radiate to the pelvis and the thighs and be associated with deep pelvic discomfort.50,51 It may be worsened by sexual intercourse and may initially be reported as sciatic pain.50,51
Diagnosis and treatment of pudendal and inferior cluneal nerve entrapment syndrome: a narrative review
Published in Acta Chirurgica Belgica, 2022
Katleen Jottard, Pierre Bonnet, Viviane Thill, Stephane Ploteau, Stefan de Wachter
For the PN several conflicting settings have been described during its passage: under the piriformis muscle, passing between the SSL and sacrotuberous (STL) ligament, entering the pudendal canal and passing the falciform process [7]. The entrapment site in the space between the SSL and STL is the most common, described in about 70% of the cases [8]. A transligamentous course of the PN through the SSL, which can even be calcified, has also been described. It is also at this level that the piriformis muscle can form a fibrous sheet around the nerve. After its passage between this ligamentous claw, the PN enters the pudendal canal. At the posterior border of the Alcock’s canal, the PN passes over the falciform process of the STL, a fibrous sheet with a sharp upper border parallel to the medial side of the ischial bone. Finally, the pudendal vessels, which are often of considerable size and can be tortuous or dilated, can constrict the nerve.